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Older patients with low Charlson score and high-risk prostate cancer benefit from radical prostatectomy

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Abstract

Introduction

The aim of the study was to identify the appropriate level of Charlson comorbidity index (CCI) in older patients (>70 years) with high-risk prostate cancer (PCa) to achieve survival benefit following radical prostatectomy (RP).

Methods

We retrospectively analyzed 1008 older patients (>70 years) who underwent RP with pelvic lymph node dissection for high-risk prostate cancer (preoperative prostate-specific antigen >20 ng/mL or clinical stage ≥T2c or Gleason ≥8) from 14 tertiary institutions between 1988 and 2014. The study population was further grouped into CCI < 2 and ≥2 for analysis. Survival rate for each group was estimated with Kaplan–Meier method and competitive risk Fine-Gray regression to estimate the best explanatory multivariable model. Area under the curve (AUC) and Akaike information criterion were used to identify ideal ‘Cut off’ for CCI.

Results

The clinical and cancer characteristics were similar between the two groups. Comparison of the survival analysis using the Kaplan–Meier curve between two groups for non-cancer death and survival estimations for 5 and 10 years shows significant worst outcomes for patients with CCI ≥ 2. In multivariate model to decide the appropriate CCI cut-off point, we found CCI 2 has better AUC and p value in log rank test.

Conclusion

Older patients with fewer comorbidities harboring high-risk PCa appears to benefit from RP. Sicker patients are more likely to die due to non-prostate cancer-related causes and are less likely to benefit from RP.

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Author Contributions

Sivaraman A, Ordaz Jurado G, Sanchez-Salas R were involved in conception and design; Sivaraman A and Ordaz Jurado G were involved in acquisition of data; Ordaz Jurado G, Sanchez-Salas R, Eric Barret Dell’Oglio P, Joniau S, Bianchi M, Briganti A, Spahn M, Bastian P, Chun J, Chlosta P, Gontero P, Graefen M, Jeffrey Karnes R, Marchioro G, Tombal B, Tosco L, Henk van der Poel H were involved in analysis and Interpretation of Data; Sivaraman A drafted the manuscript; Eric BarretDell’Oglio P, Joniau S, Bianchi M, Briganti A, Spahn M, Bastian P, Chun J, Chlosta P, Gontero P, Graefen M, Jeffrey Karnes R, Marchioro G, Tombal B, Tosco L, Henk van der Poel H critically revised the paper; Ordaz Jurado G and Briganti A performed statistical analysis; and Cathelineau X and Sanchez-Salas R supervised the manuscript.

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Authors and Affiliations

  1. Department of Urology, Institute Mutualiste Monsouris, 42, Bd Jourdan, 75674, Paris Cedex 14, France

    A. Sivaraman, G. Ordaz Jurado, X. Cathelineau, Eric Barret & R. Sanchez-Salas

  2. EMPaCT Database, Tempe, AZ, USA

    P. Dell’Oglio, S. Joniau, M. Bianchi, A. Briganti, M. Spahn, P. Bastian, J. Chun, P. Chlosta, P. Gontero, M. Graefen, R. Jeffrey Karnes, G. Marchioro, B. Tombal, L. Tosco, H. Henk van der Poel & R. Sanchez-Salas

Authors
  1. A. Sivaraman
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  2. G. Ordaz Jurado
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  3. X. Cathelineau
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  4. Eric Barret
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  5. P. Dell’Oglio
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  6. S. Joniau
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  7. M. Bianchi
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  8. A. Briganti
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  9. M. Spahn
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  10. P. Bastian
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  11. J. Chun
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  12. P. Chlosta
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  13. P. Gontero
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  14. M. Graefen
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  15. R. Jeffrey Karnes
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  16. G. Marchioro
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  17. B. Tombal
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  18. L. Tosco
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  19. H. Henk van der Poel
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  20. R. Sanchez-Salas
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Corresponding author

Correspondence to R. Sanchez-Salas.

Ethics declarations

Ethical standards

We declare that prior to the start of the study, Independent Ethical Committee (IEC) was obtained. All the patients (or the legal representative) enrolled in the study completed and signed the written informed consent form. The study was conducted in accordance with the Declaration of Helsinki and the EU clinical directive on GPC (2001/20/EC).

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Sivaraman, A., Ordaz Jurado, G., Cathelineau, X. et al. Older patients with low Charlson score and high-risk prostate cancer benefit from radical prostatectomy. World J Urol 34, 1367–1372 (2016). https://doi.org/10.1007/s00345-016-1784-8

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  • DOI: https://doi.org/10.1007/s00345-016-1784-8

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